In my last posting, I explored the idea of whether having access to a patient’s chart and lab work empowered the patient to be more proactive with their healthcare. In that posting, I remained skeptical as to whether the chart sharing feature in our EMR accomplished this. In this post, however, I want to continue exploring this feature of chart sharing and what effect it seems to be having on our patient population.

I start by saying that, generally, our patients like the chart sharing feature, regardless of how they use the data. Initially, we did not use this feature when we adopted our EMR because it was limited in what it could actually share with the patient. However, as the EMR has developed over time and labs began to be integrated into patient charts, the obvious benefit of this feature became more valuable, if for no other reason than stopping the printing out of labs, using paper and ink, for many of our patients. Not to mention that the patient could no longer lose said paper and ink lab reports.

On any given day, we enroll about 8-10 patients into the chart sharing feature that will enable them to have access to their chart. Through this feature they can see previous and upcoming appointment times, a list of prescribed medications, diagnoses, and lab results from lab companies that send back their results as integrated into the EMR. Interestingly, not one patient so far has declined the invitation to gain access to their medical chart. At the start, we e-mail all patients a brief overview of what to expect in the enrollment process, what they will find in their chart, and a temporary PIN to allow them to gain initial access. Only one person has been dissatisfied with the results thus far, and the access was subsequently deactivated at their request. Whether or not this is empowering the patients to be more proactive with their healthcare, the bottom line is that the patients like it! In fact, I wish we could give the patient even more access to their chart as many of the uploaded documents that are not integrated into the chart sharing feature. Interestingly, a recent story explored this over at Fierce Health IT.

One aspect that this shows is that the internet is an integral part of healthcare today. This is no longer so revolutionary to say in the healthcare industry. A recent article I read discussing smart phones said that only 20% of the current US population was using a smart phone, but that industry leaders expected this to increase to 80% by the year 2020. I think the same is true for how patients will use the internet in regards to their healthcare. As more doctors adopt EMRs for their practices, and as more EMRs allow for chart sharing, more patients will find that they will need access to the internet to gain access to their medical history and records. Many patients are already indicating that they want this access.

The integration of EMRs into our patient’s lives is helping to create a population of patients that understand that one way to be plugged into their doctor’s office is through the internet. We constantly have patients wanting to e-mail our doctor for advice, to report symptoms, or to request test results. It’s baffling that EMR companies have yet to figure out how to form a financially beneficial relationship with the insurance companies to provide better and faster healthcare through the internet. Many businesses and academic institutions have already figured out how to integrate the use of the internet into their business models to achieve efficient and cost-cutting results. From internet-conferencing, to document sharing applications, businesses and schools have embraced the internet with much creativity. This is only just beginning to happen in healthcare – but I believe it is coming.

I know that insurance companies are reluctant to pay for healthcare administered through an internet exchange, and some of those reasons are very good. But imagine this: the integration of Google video chat or Skype with an EMR that will allow for the doctor and patient to login to the same EMR where the patient’s chart is located and have a discussion about lab tests or radiology results. Not all patient-physician interactions include a hands-on physical exam. If the doctor finds something in the results or discussion that warrants a more through physical exam, then one could be set up for the patient at the end of the “e-visit”. Maybe the reason insurance companies are reluctant to pay for healthcare in this way is that they know the patients will embrace the ease of access and begin using the insurance policy more. Hmm… The less people use healthcare access, the more premiums the insurance company gets to keep. But I digress…

The EMR is changing not just the relationship between the physician and patient, but it is changing the patient themself. Patients in our office are slowly becoming used to the integration of electronic medicine. They have learned to expect to find their electronically sent prescriptions waiting for them at their pharmacies, or to find access to their labs, list of medications and upcoming appointment times in their online chart. Patients in our office are slowly being taught to fax their records to the office because our online fax will automatically turn their documents into a PDF file, which can then be uploaded easily to their chart. Patients are learning to expect all bills from our office to be e-mailed to them rather than physically mailed. Patients are learning that during the visit, for the doctor to “look back in the chart at previous notes,” requires waiting for the doctor to click through an electronic record at the computer on the doctor’s desk rather than flip through a paper chart. Some patients are even learning that to have a summary of what the doctor recommended can now be e-mailed to them upon their request.

The patient that is the least frustrated with the technology integrated into the healthcare we provide in our office is the patient who can adapt to this technically changing environment. We certainly have patients who get frustrated adapting or who do not even use e-mail, but these are only a few. Unfortunately, there is no way for patients who cannot adapt to an electronically based medical office to survive in our office. We do not have special paper charts for a few selected group of patients, and our doctor rarely writes paper prescriptions anymore.

Is our office just the sign of the times? Perhaps. But we have found that having an electronically-based medical office is more efficient, cuts down on staff requirements and helps us to compete with a stronger financial footprint in today’s marketplace. We are not turning back in this office, and I’m not sure the majority of our patients want us to. In fact, I think they are waiting for the next level of technical innovation to come out that will enable them to get their healthcare needs taken care of in an even more efficient way.

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.